Despite recent progress, Liberia still experiences poor child and maternal health indic... more Despite recent progress, Liberia still experiences poor child and maternal health indicators due to: inadequate resources, low awareness of preventive measures, and a lack of access to health services, amongst other factors. With an aim to improve health conditions and to increase access to a package of basic Reproductive Maternal Neonatal and Child Health (RMNCH) services, BRAC Liberia’s health programme expanded operations in 2013. This Intermediary Assessment Report aims to assess the impact of the RMNCH programme in Liberia to date.
BRAC Liberia’s Independent Research and Evaluation Unit (REU-LIB) conducted an assessment in seven counties in Liberia, (comprised of four treatment counties and three control counties), to collect information on health seeking behaviour and health outcomes. The survey followed a cross sectional design and utilised data from households with at least one child under five years old. The total sample size consisted of 1,960 households (980 treatment households and 980 control households).
The survey revealed that the RMNCH programme in Liberia is making visible progress towards mostly output indicator targets in the treatment areas, overall there is little statistical difference between outcome level indicators when compared to the control group. For instance, the survey found higher awareness about signs and symptoms of common childhood diseases namely; malaria, diarrheoa and pneumonia among women in the treatment areas, children under five in the treatment areas were 13% more likely to receive antimalarial drugs to treat malaria within 24 hours.
Concerning outcome indicators, Programme had pronounced impact on contraceptive use among women; use of modern family planning services was reported 9% more among sexually active women aged 15 – 49 in the treatment than women in the control areas area during the past year prior to data collection. Also women and men in the treatment areas expressed improved attitudes towards HIV/AIDs. Although not statistically different, the survey found a minor (5%) difference in the proportion of babies who were exclusively breast fed during the first six months in treatment areas, which indicates gradual progress within the programme.
At the same time the results show that there is no statistically significant difference between the treatment and control groups for most of the outcome indicators.
Programme is challenged by lack of availability of certain health products due to Government of Liberia’s policy restrictions, not for CHPs to be availed with drugs, as a result the survey found inadequate knowledge and management of common childhood diseases using the most effective treatment (both ORS and Zinc, and ACTs) to treat children U5 of diarrhea and malaria, respectively in both study areas.
Programmatic Procedure to operate within 4km radius from the branch office also seems to inhibit Programme’s progress. For instance majority of the mothers (86% in the treatment and 87% in the control areas) who had a live birth one year preceding the survey in both study areas attended ANC (4 checks plus), and high proportions of mothers who delivered one year before the survey received PNC (75% in the treatment and 76% in the control areas). This implies a concentration of Programme operations in urban areas, which eases accessibility to health services in both areas.
The impact of Ebola crisis is another major reason responsible for slowing down Programme’s success. The crisis led to a halt in Programme activities, a shortage and minimised acceptance of health workers to take care of the mothers, as well as mistrust for health facilities among mothers to seek health services due to fear of being infected. The survey found live births during the past one year in the treatment areas were 8% less likely to have been delivered by a skilled health provider. In addition, PNC coverage within one week after delivery was below average (45% and 42%) in the treatment and control areas, respectively.
In addition, the Ebola crisis presented opportunities which made the population adopt improved hygiene practices and acquire improved general health knowledge. Therefore programme couldn’t obtain measurable difference in the treatment areas regarding proper hand washing practice and knowledge related to Pregnancy and related care (PRC).
However, financial constraints, long distances to the health facilities, poor transport and having to seek permission to go and seek health care could have obstructed the programme from achieving significant effects related to maternal health outcomes.
The survey also highlighted the male gender as another challenge for Programme to achieve visible impact. For example within the treatment area the use of modern family
planning methods was 13% less among men compared to women and men generally practiced poor hand washing practices (76% men compared to 89% women).
In addition the survey clearly showed that adolescent girls (aged 15 – 19) and single mothers were disadvantaged in all maternal and child health outcomes. The survey captured a 19% variation in knowledge about signs and symptoms of children U5 among adolescent girls compared to adult women. Single mothers were 8% less likely to have attended ANC (4 checks plus) and to have received PNC promptly (within one week) after delivery (38% compared to 50% of the married women).
It is advised that Programme should focus on the promotion of ACTs, and Zinc to increase treatment coverage outcomes among children, expand its activities to distant areas (beyond the 4kms radius), to reach the most underserved. The RMNCH programme requires further strengthening of referral linkages to improve health professionals’ care towards mothers and should consider social protection measure to enhance affordability of health services and health seeking behavior. Further, greater male involvement should be considered important for Programme to deal with the gender differentials, as well as pay attention to targeting adolescent girls and single mothers in order to better realise the significant differences from the control.
After enormous attention to EVD outbreak, Liberia registered strong numbers of survivors and orp... more After enormous attention to EVD outbreak, Liberia registered strong numbers of survivors and orphans. The affected populations displayed poor health, material insecurity, trauma, distress and experienced stigma among many other needs. BRAC Liberia introduced the PSS project during late 2014 in seven counties of Liberia namely; Bong, Grand Bassa, Grand Cape Mount, Lofa, Margibi, Montserrado and Nimba, to improve the well-being, alleviate distress, enhance coping skills and build resilience of people affected by Ebola and for survivors of EVD in Liberia, as well as to improve community attitudes towards EVD survivors and family members. An assessment was conducted to assess the project’s contribution towards improving beneficiaries’ social, economic, health and mental wellbeing. As well as, influence on community perceptions and attitudes towards EVD survivors and people from affected families. The survey applied both qualitative and quantitative designs and utilised data from a total of randomly selected 738 respondents who included; 252 EVD survivors, 282 households with EVD orphans and 204 respondents from communities. Also the survey consisted of seven FGDs and 14 in-depth interviews with the community people. Results indicated that comprehensive knowledge about EVD signs, symptoms and prevention was found inadequate and the quest to know the cause of EVD was captured among community people. Financial grant boosted survivors’ economic engagement. Counseling elevated survivors’ and orphans’ social interaction and ambition. In addition, improvement in peoples’ attitudes towards EVD survivors and affected people were reported. On the other hand, the project registered slow progress on peoples’ perceptions regarding EVD as well as survivors’ and orphans’ health and mental wellbeing; 38% felt ashamed to be EVD survivors. Good proportions of survivors’ and orphans experienced health problems such as intensive headache, severe body aches, and general weaknesses. Also 60% of survivors and 42% of orphans experienced anxiety that hampered their activities and mostly would refuse to eat and crying to cope. In the communities, 36% felt that a child who survived EVD or who came from affected families could put others at risk of catching the disease. Also 20% felt that they could catch EVD by hugging or touching a survivor, implying desirable influence can be obtainable after long exposure. The young and old experienced poorer health condition, and suffered psychological distress.
Despite recent progress, Liberia still experiences poor child and maternal health indic... more Despite recent progress, Liberia still experiences poor child and maternal health indicators due to: inadequate resources, low awareness of preventive measures, and a lack of access to health services, amongst other factors. With an aim to improve health conditions and to increase access to a package of basic Reproductive Maternal Neonatal and Child Health (RMNCH) services, BRAC Liberia’s health programme expanded operations in 2013. This Intermediary Assessment Report aims to assess the impact of the RMNCH programme in Liberia to date.
BRAC Liberia’s Independent Research and Evaluation Unit (REU-LIB) conducted an assessment in seven counties in Liberia, (comprised of four treatment counties and three control counties), to collect information on health seeking behaviour and health outcomes. The survey followed a cross sectional design and utilised data from households with at least one child under five years old. The total sample size consisted of 1,960 households (980 treatment households and 980 control households).
The survey revealed that the RMNCH programme in Liberia is making visible progress towards mostly output indicator targets in the treatment areas, overall there is little statistical difference between outcome level indicators when compared to the control group. For instance, the survey found higher awareness about signs and symptoms of common childhood diseases namely; malaria, diarrheoa and pneumonia among women in the treatment areas, children under five in the treatment areas were 13% more likely to receive antimalarial drugs to treat malaria within 24 hours.
Concerning outcome indicators, Programme had pronounced impact on contraceptive use among women; use of modern family planning services was reported 9% more among sexually active women aged 15 – 49 in the treatment than women in the control areas area during the past year prior to data collection. Also women and men in the treatment areas expressed improved attitudes towards HIV/AIDs. Although not statistically different, the survey found a minor (5%) difference in the proportion of babies who were exclusively breast fed during the first six months in treatment areas, which indicates gradual progress within the programme.
At the same time the results show that there is no statistically significant difference between the treatment and control groups for most of the outcome indicators.
Programme is challenged by lack of availability of certain health products due to Government of Liberia’s policy restrictions, not for CHPs to be availed with drugs, as a result the survey found inadequate knowledge and management of common childhood diseases using the most effective treatment (both ORS and Zinc, and ACTs) to treat children U5 of diarrhea and malaria, respectively in both study areas.
Programmatic Procedure to operate within 4km radius from the branch office also seems to inhibit Programme’s progress. For instance majority of the mothers (86% in the treatment and 87% in the control areas) who had a live birth one year preceding the survey in both study areas attended ANC (4 checks plus), and high proportions of mothers who delivered one year before the survey received PNC (75% in the treatment and 76% in the control areas). This implies a concentration of Programme operations in urban areas, which eases accessibility to health services in both areas.
The impact of Ebola crisis is another major reason responsible for slowing down Programme’s success. The crisis led to a halt in Programme activities, a shortage and minimised acceptance of health workers to take care of the mothers, as well as mistrust for health facilities among mothers to seek health services due to fear of being infected. The survey found live births during the past one year in the treatment areas were 8% less likely to have been delivered by a skilled health provider. In addition, PNC coverage within one week after delivery was below average (45% and 42%) in the treatment and control areas, respectively.
In addition, the Ebola crisis presented opportunities which made the population adopt improved hygiene practices and acquire improved general health knowledge. Therefore programme couldn’t obtain measurable difference in the treatment areas regarding proper hand washing practice and knowledge related to Pregnancy and related care (PRC).
However, financial constraints, long distances to the health facilities, poor transport and having to seek permission to go and seek health care could have obstructed the programme from achieving significant effects related to maternal health outcomes.
The survey also highlighted the male gender as another challenge for Programme to achieve visible impact. For example within the treatment area the use of modern family
planning methods was 13% less among men compared to women and men generally practiced poor hand washing practices (76% men compared to 89% women).
In addition the survey clearly showed that adolescent girls (aged 15 – 19) and single mothers were disadvantaged in all maternal and child health outcomes. The survey captured a 19% variation in knowledge about signs and symptoms of children U5 among adolescent girls compared to adult women. Single mothers were 8% less likely to have attended ANC (4 checks plus) and to have received PNC promptly (within one week) after delivery (38% compared to 50% of the married women).
It is advised that Programme should focus on the promotion of ACTs, and Zinc to increase treatment coverage outcomes among children, expand its activities to distant areas (beyond the 4kms radius), to reach the most underserved. The RMNCH programme requires further strengthening of referral linkages to improve health professionals’ care towards mothers and should consider social protection measure to enhance affordability of health services and health seeking behavior. Further, greater male involvement should be considered important for Programme to deal with the gender differentials, as well as pay attention to targeting adolescent girls and single mothers in order to better realise the significant differences from the control.
After enormous attention to EVD outbreak, Liberia registered strong numbers of survivors and orp... more After enormous attention to EVD outbreak, Liberia registered strong numbers of survivors and orphans. The affected populations displayed poor health, material insecurity, trauma, distress and experienced stigma among many other needs. BRAC Liberia introduced the PSS project during late 2014 in seven counties of Liberia namely; Bong, Grand Bassa, Grand Cape Mount, Lofa, Margibi, Montserrado and Nimba, to improve the well-being, alleviate distress, enhance coping skills and build resilience of people affected by Ebola and for survivors of EVD in Liberia, as well as to improve community attitudes towards EVD survivors and family members. An assessment was conducted to assess the project’s contribution towards improving beneficiaries’ social, economic, health and mental wellbeing. As well as, influence on community perceptions and attitudes towards EVD survivors and people from affected families. The survey applied both qualitative and quantitative designs and utilised data from a total of randomly selected 738 respondents who included; 252 EVD survivors, 282 households with EVD orphans and 204 respondents from communities. Also the survey consisted of seven FGDs and 14 in-depth interviews with the community people. Results indicated that comprehensive knowledge about EVD signs, symptoms and prevention was found inadequate and the quest to know the cause of EVD was captured among community people. Financial grant boosted survivors’ economic engagement. Counseling elevated survivors’ and orphans’ social interaction and ambition. In addition, improvement in peoples’ attitudes towards EVD survivors and affected people were reported. On the other hand, the project registered slow progress on peoples’ perceptions regarding EVD as well as survivors’ and orphans’ health and mental wellbeing; 38% felt ashamed to be EVD survivors. Good proportions of survivors’ and orphans experienced health problems such as intensive headache, severe body aches, and general weaknesses. Also 60% of survivors and 42% of orphans experienced anxiety that hampered their activities and mostly would refuse to eat and crying to cope. In the communities, 36% felt that a child who survived EVD or who came from affected families could put others at risk of catching the disease. Also 20% felt that they could catch EVD by hugging or touching a survivor, implying desirable influence can be obtainable after long exposure. The young and old experienced poorer health condition, and suffered psychological distress.
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BRAC Liberia’s Independent Research and Evaluation Unit (REU-LIB) conducted an assessment in seven counties in Liberia, (comprised of four treatment counties and three control counties), to collect information on health seeking behaviour and health outcomes. The survey followed a cross sectional design and utilised data from households with at least one child under five years old. The total sample size consisted of 1,960 households (980 treatment households and 980 control households).
The survey revealed that the RMNCH programme in Liberia is making visible progress towards mostly output indicator targets in the treatment areas, overall there is little statistical difference between outcome level indicators when compared to the control group. For instance, the survey found higher awareness about signs and symptoms of common childhood diseases namely; malaria, diarrheoa and pneumonia among women in the treatment areas, children under five in the treatment areas were 13% more likely to receive antimalarial drugs to treat malaria within 24 hours.
Concerning outcome indicators, Programme had pronounced impact on contraceptive use among women; use of modern family planning services was reported 9% more among sexually active women aged 15 – 49 in the treatment than women in the control areas area during the past year prior to data collection. Also women and men in the treatment areas expressed improved attitudes towards HIV/AIDs. Although not statistically different, the survey found a minor (5%) difference in the proportion of babies who were exclusively breast fed during the first six months in treatment areas, which indicates gradual progress within the programme.
At the same time the results show that there is no statistically significant difference between the treatment and control groups for most of the outcome indicators.
Programme is challenged by lack of availability of certain health products due to Government of Liberia’s policy restrictions, not for CHPs to be availed with drugs, as a result the survey found inadequate knowledge and management of common childhood diseases using the most effective treatment (both ORS and Zinc, and ACTs) to treat children U5 of diarrhea and malaria, respectively in both study areas.
Programmatic Procedure to operate within 4km radius from the branch office also seems to inhibit Programme’s progress. For instance majority of the mothers (86% in the treatment and 87% in the control areas) who had a live birth one year preceding the survey in both study areas attended ANC (4 checks plus), and high proportions of mothers who delivered one year before the survey received PNC (75% in the treatment and 76% in the control areas). This implies a concentration of Programme operations in urban areas, which eases accessibility to health services in both areas.
The impact of Ebola crisis is another major reason responsible for slowing down Programme’s success. The crisis led to a halt in Programme activities, a shortage and minimised acceptance of health workers to take care of the mothers, as well as mistrust for health facilities among mothers to seek health services due to fear of being infected. The survey found live births during the past one year in the treatment areas were 8% less likely to have been delivered by a skilled health provider. In addition, PNC coverage within one week after delivery was below average (45% and 42%) in the treatment and control areas, respectively.
In addition, the Ebola crisis presented opportunities which made the population adopt improved hygiene practices and acquire improved general health knowledge. Therefore programme couldn’t obtain measurable difference in the treatment areas regarding proper hand washing practice and knowledge related to Pregnancy and related care (PRC).
However, financial constraints, long distances to the health facilities, poor transport and having to seek permission to go and seek health care could have obstructed the programme from achieving significant effects related to maternal health outcomes.
The survey also highlighted the male gender as another challenge for Programme to achieve visible impact. For example within the treatment area the use of modern family
planning methods was 13% less among men compared to women and men generally practiced poor hand washing practices (76% men compared to 89% women).
In addition the survey clearly showed that adolescent girls (aged 15 – 19) and single mothers were disadvantaged in all maternal and child health outcomes. The survey captured a 19% variation in knowledge about signs and symptoms of children U5 among adolescent girls compared to adult women. Single mothers were 8% less likely to have attended ANC (4 checks plus) and to have received PNC promptly (within one week) after delivery (38% compared to 50% of the married women).
It is advised that Programme should focus on the promotion of ACTs, and Zinc to increase treatment coverage outcomes among children, expand its activities to distant areas (beyond the 4kms radius), to reach the most underserved. The RMNCH programme requires further strengthening of referral linkages to improve health professionals’ care towards mothers and should consider social protection measure to enhance affordability of health services and health seeking behavior. Further, greater male involvement should be considered important for Programme to deal with the gender differentials, as well as pay attention to targeting adolescent girls and single mothers in order to better realise the significant differences from the control.
interviews with the community people.
Results indicated that comprehensive knowledge about EVD signs, symptoms and prevention was found inadequate and the quest to know the cause of EVD was captured among community people. Financial grant boosted survivors’ economic engagement. Counseling elevated survivors’ and orphans’ social interaction and ambition. In addition, improvement in peoples’ attitudes towards EVD survivors and affected people were reported. On the other hand, the project registered slow progress on peoples’ perceptions regarding EVD as well as survivors’ and orphans’ health and mental wellbeing; 38% felt ashamed to be EVD survivors. Good proportions of survivors’ and orphans experienced health problems such as intensive headache, severe body aches, and general weaknesses. Also 60% of survivors and 42% of orphans experienced anxiety that hampered their activities and mostly would refuse to eat and crying to cope. In the communities, 36% felt that a child who survived EVD or who came from affected families could put others at risk of catching the disease. Also 20% felt that they could catch EVD by hugging or touching a survivor, implying desirable influence can be obtainable after long exposure. The young and old experienced poorer health condition, and suffered psychological distress.
BRAC Liberia’s Independent Research and Evaluation Unit (REU-LIB) conducted an assessment in seven counties in Liberia, (comprised of four treatment counties and three control counties), to collect information on health seeking behaviour and health outcomes. The survey followed a cross sectional design and utilised data from households with at least one child under five years old. The total sample size consisted of 1,960 households (980 treatment households and 980 control households).
The survey revealed that the RMNCH programme in Liberia is making visible progress towards mostly output indicator targets in the treatment areas, overall there is little statistical difference between outcome level indicators when compared to the control group. For instance, the survey found higher awareness about signs and symptoms of common childhood diseases namely; malaria, diarrheoa and pneumonia among women in the treatment areas, children under five in the treatment areas were 13% more likely to receive antimalarial drugs to treat malaria within 24 hours.
Concerning outcome indicators, Programme had pronounced impact on contraceptive use among women; use of modern family planning services was reported 9% more among sexually active women aged 15 – 49 in the treatment than women in the control areas area during the past year prior to data collection. Also women and men in the treatment areas expressed improved attitudes towards HIV/AIDs. Although not statistically different, the survey found a minor (5%) difference in the proportion of babies who were exclusively breast fed during the first six months in treatment areas, which indicates gradual progress within the programme.
At the same time the results show that there is no statistically significant difference between the treatment and control groups for most of the outcome indicators.
Programme is challenged by lack of availability of certain health products due to Government of Liberia’s policy restrictions, not for CHPs to be availed with drugs, as a result the survey found inadequate knowledge and management of common childhood diseases using the most effective treatment (both ORS and Zinc, and ACTs) to treat children U5 of diarrhea and malaria, respectively in both study areas.
Programmatic Procedure to operate within 4km radius from the branch office also seems to inhibit Programme’s progress. For instance majority of the mothers (86% in the treatment and 87% in the control areas) who had a live birth one year preceding the survey in both study areas attended ANC (4 checks plus), and high proportions of mothers who delivered one year before the survey received PNC (75% in the treatment and 76% in the control areas). This implies a concentration of Programme operations in urban areas, which eases accessibility to health services in both areas.
The impact of Ebola crisis is another major reason responsible for slowing down Programme’s success. The crisis led to a halt in Programme activities, a shortage and minimised acceptance of health workers to take care of the mothers, as well as mistrust for health facilities among mothers to seek health services due to fear of being infected. The survey found live births during the past one year in the treatment areas were 8% less likely to have been delivered by a skilled health provider. In addition, PNC coverage within one week after delivery was below average (45% and 42%) in the treatment and control areas, respectively.
In addition, the Ebola crisis presented opportunities which made the population adopt improved hygiene practices and acquire improved general health knowledge. Therefore programme couldn’t obtain measurable difference in the treatment areas regarding proper hand washing practice and knowledge related to Pregnancy and related care (PRC).
However, financial constraints, long distances to the health facilities, poor transport and having to seek permission to go and seek health care could have obstructed the programme from achieving significant effects related to maternal health outcomes.
The survey also highlighted the male gender as another challenge for Programme to achieve visible impact. For example within the treatment area the use of modern family
planning methods was 13% less among men compared to women and men generally practiced poor hand washing practices (76% men compared to 89% women).
In addition the survey clearly showed that adolescent girls (aged 15 – 19) and single mothers were disadvantaged in all maternal and child health outcomes. The survey captured a 19% variation in knowledge about signs and symptoms of children U5 among adolescent girls compared to adult women. Single mothers were 8% less likely to have attended ANC (4 checks plus) and to have received PNC promptly (within one week) after delivery (38% compared to 50% of the married women).
It is advised that Programme should focus on the promotion of ACTs, and Zinc to increase treatment coverage outcomes among children, expand its activities to distant areas (beyond the 4kms radius), to reach the most underserved. The RMNCH programme requires further strengthening of referral linkages to improve health professionals’ care towards mothers and should consider social protection measure to enhance affordability of health services and health seeking behavior. Further, greater male involvement should be considered important for Programme to deal with the gender differentials, as well as pay attention to targeting adolescent girls and single mothers in order to better realise the significant differences from the control.
interviews with the community people.
Results indicated that comprehensive knowledge about EVD signs, symptoms and prevention was found inadequate and the quest to know the cause of EVD was captured among community people. Financial grant boosted survivors’ economic engagement. Counseling elevated survivors’ and orphans’ social interaction and ambition. In addition, improvement in peoples’ attitudes towards EVD survivors and affected people were reported. On the other hand, the project registered slow progress on peoples’ perceptions regarding EVD as well as survivors’ and orphans’ health and mental wellbeing; 38% felt ashamed to be EVD survivors. Good proportions of survivors’ and orphans experienced health problems such as intensive headache, severe body aches, and general weaknesses. Also 60% of survivors and 42% of orphans experienced anxiety that hampered their activities and mostly would refuse to eat and crying to cope. In the communities, 36% felt that a child who survived EVD or who came from affected families could put others at risk of catching the disease. Also 20% felt that they could catch EVD by hugging or touching a survivor, implying desirable influence can be obtainable after long exposure. The young and old experienced poorer health condition, and suffered psychological distress.